Comparison of non-invasive diagnostic modalities for ocular surface squamous neoplasia at a tertiary hospital, South Africa,Eye

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Comparison of non-invasive diagnostic modalities for ocular surface squamous neoplasia at a tertiary hospital, South Africa
Eye ( IF 2.8 ) Pub Date : 2023-11-23 , DOI: 10.1038/s41433-023-02833-0
Roland Hӧllhumer ₁ , Pamela Michelow ₂ , Susan Williams ₁

Affiliation

Aims

The aim of the study is to assess non-invasive diagnostic modalities for ocular surface squamous neoplasia (OSSN) when compared to histology.

Methods

A prospective case–control study was conducted of patients presenting with conjunctival masses at a tertiary eye hospital in Johannesburg, South Africa. Patients completed an interview and had three non-invasive diagnostic tests: optical coherence tomography, impression cytology and methylene blue stain. A biopsy with histology was performed as the gold standard to confirm the diagnosis.

Results

One hundred and eighty-two conjunctival masses of 175 patients were evaluated. There were 135 lesions identified as OSSN on biopsy and 47 lesions were benign on histology. Optical coherence tomography had a sensitivity and specificity of 87.2% (95% CI: 80.0–92.5) and 75.6% (95% CI: 60.5–87.1), respectively, when an epithelial thickness cutoff of 140 um was used. Shadowing was found in 46% of cases due to leukoplakia or increased thickness of the mass. Cytology had a sensitivity of 72.4% (95% CI: 62.5–81.0) and a specificity of 74.3% (95% CI: 56.7–87.5). Twenty-seven per cent of cytology specimens were excluded from analysis due to inadequate cellularity. Methylene blue had a high sensitivity of 91.9% (95% CI: 85.9–95.9), but low specificity of 55.3% (95% CI: 40.1–69.8).

Conclusion

Optical coherence tomography had a high sensitivity and specificity as a non-invasive test and liquid-based cytology performed well but had a lower sensitivity and specificity than with optical coherence tomography. Methylene blue performed well as a screening test, with a high sensitivity but low specificity.

中文翻译：

南非某三级医院眼表鳞状细胞瘤无创诊断方式的比较

目标

该研究的目的是与组织学比较，评估眼表鳞状细胞瘤（OSSN）的非侵入性诊断方式。

方法

对南非约翰内斯堡一家三级眼科医院出现结膜肿块的患者进行了一项前瞻性病例对照研究。患者完成了面谈并进行了三项非侵入性诊断测试：光学相干断层扫描、印模细胞学和亚甲蓝染色。进行组织学活检作为确认诊断的金标准。

结果

对 175 名患者的 182 个结膜肿块进行了评估。活检中有 135 个病变被鉴定为 OSSN，组织学上有 47 个病变被鉴定为良性。当使用 140 um 的上皮厚度截止值时，光学相干断层扫描的敏感性和特异性分别为 87.2%（95% CI：80.0-92.5）和 75.6%（95% CI：60.5-87.1）。 46% 的病例由于白斑或肿块厚度增加而出现阴影。细胞学检测的敏感性为 72.4% (95% CI: 62.5–81.0)，特异性为 74.3% (95% CI: 56.7–87.5)。 27% 的细胞学标本由于细胞结构不足而被排除在分析之外。亚甲蓝的敏感性较高，为 91.9%（95% CI：85.9-95.9），但特异性较低，为 55.3%（95% CI：40.1-69.8）。